Credentialing Specialist

BayCare is currently in search of our newest Credentialing Specialist who is passionate about providing outstanding customer service to our community. BayCare’s top priority is the health and well-being of our communities as Tampa Bay's leading multi-specialty group with more than 600 providers practicing 45 specialties in over 175 outpatient locations throughout the Tampa Bay and west central Florida regions.

The Credentialing Specialist is responsible for:

· Initiates and maintains credentialing managed care enrollment and hospital privileges for BayCare physicians and providers in accordance with NCQA, CMS, AHCA, State and Federal guidelines and regulations, as well as Department Policies, to ensure compliance with credentialing standards.

· Completes primary source verifications and assesses the provider's qualifications to ensure the providers meet BayCare's quality standards.

· Documents all verifications and data in the credentialing database to produce credentialing files that meet BayCare's quality standards within the time frames required by BayCare.

· Ensures providers remain compliant with all licensing and board requirements and will assist providers with renewals.

· Enrolls and maintains managed care enrollment by providing updates to the managed care plans and will resolve errors and issues by coordinating with the plans, the CBO and the Managed Care contracting department.

Education

· High School or Equivalent

Experience

· 1 year - Credentialing; Or - 1 year - Managed Care

Credentials:
* Preferred - CPCS (Credentialing)

Specific Skills:

· Critical thinking skills; Computer skills appropriate to position

· Medical Terminology use and understanding

· Work with a team; Written and verbal communication skills

· Time management skills; Customer service skills

· Work independently; Problem solving

Status: Full Time, Exempt: No

Shift Hours: 8:00 A.M. - 5:00 P.M. (May Vary)

Shift: Shift 1

Shift 1 = Days, 2 = Evenings,  3 = Nights,  4 = Varies

Weekend Work: None

On Call: No

How often will this team member be working remotely? Always

Equal Opportunity Employer Veterans/Disabled